Capnography in Outpatient Anesthesia

Abstract

Abstract The concept of outpatient anesthesia first came up in the 1970s. Performing planned surgery of patients on the same day and then being discharged is called outpatient surgery, and the anesthesia applied in the same session is called outpatient anesthesia. Outpatient surgery is not performed for every patient. There are many factors that determine whether patient population scheduled for outpatient surgery is suitable for outpatient surgery. End-tidal carbon dioxide (ETCO2) is the CO level released at the end of expiration. ETCO2 reflects the adequacy of ventilation and perfusion. ETCO2 measurement can be performed with many techniques. Infrared spectrography is the most common technique. It can be used in intubated and tracheostomized patients who are provided with respiratory support with a mechanical ventilator, as well as in patients who are not intubated and undergo sedoanalgesia, allowing the monitoring of respiration by measuring. The capnogram consists of two main components, inspiration and expiration, and these components point to four separate phases. It is known that drugs used in sedation and analgesia can often have negative effects on respiratory system. Therefore, patients’ oxygenation and hemodynamic status should be closely monitored. It can continuously monitor frequency and depth of patients’ breathing using a capnograph. An increase in amount of ETCO2 or a decrease in respiratory pattern is interpreted as respiratory depression. In addition to capnography, a parameter showing respiratory status, defined as "Integrated Pulmonary Index" (IPI), consisting of capnography, pulse oximetry, respiratory rate, and mathematical analysis of heart rate, is also used in cases where outpatient sedation is applied.

Keywords

• Outpatient Anesthesia
• Capnography
• Integrated Pulmonary Index

References

1. 1. Sarihasan B, Kelsaka E, Tafi N. Günübirlik Anestezi Uygulaması. O.M.Ü. Tıp Dergisi. 2008; 25(3):111-15.
2. 2. Özbilgin Ş, Kılıç Y, Aycan İ, Çağlar T. Günübirlik Uygulama KlavuzuTürk Anesteziyoloji ve Reanimasyon Derneği (TARD). 2012;1-56.
3. 3. Elam Jo, Brown Es, Ten Pas Rh. Carbon dioxide homeostasis during anesthesia. I. Instrumentation. Anesthesiol. 1955; 16(6):876-85.
4. 4. Rajan N, Rosero EB, Joshi GP. Patient Selection for Adult Ambulatory Surgery: A Narrative Review. Anesth Analg. 2021; 133(6):1415-30.
5. 5. Joshi GP. Enhanced recovery pathways for ambulatory surgery. Curr Opin Anaesthesiol. 2020; 33(6):711-17.
6. 6. Richardson M, Moulton K, Rabb D, Kindopp S, Pishe T, Yan C, Akpinar I, Tsoi B, Chuck A. Capnography for Monitoring End-Tidal CO2 in Hospital and Pre-hospital Settings: A Health Technology Assessment [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016; PMID: 27227208.
7. 7. Jaffe MB. Infrared measurement of carbon dioxide in the human breath: “breathe-through” devices from tyndall to the present day. Anesth Analg. 2008; 107(3):890-904.
8. 8. Patil J. J., Maloney D.G. Measurement of pulse oximetry, capnography and pH. Anaesth Intensive Care Med. 2014; 15(11):522-25.

9. 9. Hochwald O, Borenstein-Levin L, Dınur G, Jubran H, Ben-David S, Kugelman A. Continuous noninvasive carbon dioxide monitoring in neonates: From theory to standard of care. Pediatrics. 2019; 144(1):1-12.
10. 10. Maclennan T, McCurry R. Capnography-what is it all about? Vet Nurs J. 2020; 35(8):231-34.
11. 11. Satoh K, Ohashi A, Kumagai M, Sato M, Kuji A, Joh S. Evaluation of Differences between PaCO 2 and ETCO 2 by Age as Measured during General Anesthesia with Patients in a Supine Position . J Anesthesiol. 2015; 2015:1-5.
12. 12. Genç Moralar D, Kesici S. Anestezi doktorlarının peroperatif end-tidal karbondioksit monitörizasyon uygulamaları. SDÜ Tıp Fakültesi Derg. 2019; 26(3):312-18.
13. 13. Koyama T, Kobayashi M, Ichikawa T, Wakabayashi Y, Abe H. Technology Applications of Capnography Waveform Analytics for Evaluation of Heart Failure Severity. J Cardiovasc Transl Res. 2020; 13(6):1044-54.
14. 14. Karcioğlu Ö. Kritik Hasta Bakımında Kapnografinin Rolü . Cerrahpaşa J Med. 2014: 1-12.
15. 15. İyilikçi İ, Ökesli SE, Erdost HA. Ameliyathane Dışı Uygulamaları Klavuzu. Türk Anesteziyoloji ve Reanimasyon Derneği (TARD) 2015;1-35.
16. 16. Wadhwa V, Gupta K, Vargo JJ. Monitoring standards in sedation and analgesia: The odyssey of capnography in sedation for gastroenterology procedures. Curr Opin Anaesthesiol. 2019; 32(4):453-56.
17. 17. Özyılmaz E. Derleme / Review Kapnografi ve Yoğun Bakım Ünitesinde Kullanımı. Solunum Hastalıkları. 2009; 20(3):126-130.
18. 18. Thompson JE, Jaffe MB. Capnographic waveforms in the mechanically ventilated patient. Respir Care. 2005; 50(1):100-108.
19. 19. Prathanvanich P, Chand B. The role of capnography during upper endoscopy in morbidly obese patients: A prospective study. Surg Obes Relat Dis. 2015; 11(1):193-98.
20. 20. Langhan Melissa L, Shabanova Veronika, Li Fang-Yong, Bernstein Steven L SED. A Randomized Controlled Trial of Capnography During Sedation in a Pediatric Emergency Setting. Am J Emerg Med. 2015; 33(1):515-525.
21. 21. Turan G, Taş BA, Demiroluk Ö, et al. Endoskopik Girişimlerde Sedasyon Uygulamasında “Integrated Pulmonary Index.” Boğaziçi Tıp Dergi̇si̇. 2015; 2(3)3-6.
22. 22. Chhajed PN, Gehrer S, Pandey K V., et al. Utility of transcutaneous capnography for optimization of non-invasive ventilation pressures. J Clin Diagnostic Res. 2016; 10(9):OC06-OC09.
23. 23. Mallat J, Vallet B. Mucosal and cutaneous capnometry for the assessment of tissue hypoperfusion. Minerva Anestesiol. 2018; 84(1):68-80.
24. 24. Mohr NM, Stoltze A, Ahmed A, Kiscaden E, Shane D. Using continuous quantitative capnography for emergency department procedural sedation: a systematic review and cost-effectiveness analysis. Intern Emerg Med. 2018; 13(1):75-85.
25. 25. Brady P, McCreary C, O'Halloran KD, Gallagher C. Squamous Papilloma Causing Airway Obstruction During Conscious Sedation. Anesth Prog. 2017; 64(3):168-70.